The Sentinel Lymph Node Concept

The sentinel lymph node concept is meeting with steadily growing interest and is being extended to the different sites of the primaries. In addition, the concept is being applied in an increasingly sophisticated manner. In this book the practical application of the sentinel node concept is evaluated from the points of view of pathology, radiodiagnosis and nuclear medicine diagnostics, surgical treatment and clinical oncology. The concept is analyzed for breast cancer, malignant melanoma, tumors of the face, oropharynx, lung, gastrointestinal and urogenital tract. The first part of the book describes the function and use of the nuclear medicine equipment, the tracers used, colloid solutions and modern developments in histological and immunohistochemical lymph node investigations, as well as possible pitfalls. The consequences of false-negative results are clearly delineated. In the second part, specific tumor-related problems are described.

The sentinel node concept and its practical applications are analyzed for breast cancer, malignant melanoma, tumors of the face, oropharynx, lung, gastrointestinal, and urogenital tract. The first part of the book describes the function and use of the nuclear medicine equipment, the tracers used, colloid solutions and modern developments in histological and immunohistochemical lymph node investigations, as well as possible pitfalls. In the second part, specific tumor-related problems are described.

General Part.- Definition of the Sentinel Lymph Node and Basic Principles of Detection.- Main Techniques of Sentinel Lymph Node Labeling.- Different Aspects Dependent on Type and Localization of the Primary.- Basic Strategies in Sentinel Node Detection and Exclusion or Verification of Cancer Metastasis into the Regional Node(s).- Positron Emission Tomography: Significance for Preoperative N-Staging.- Detection and Radiological Imaging of SLN.- Lymphatic Drainage to the SLN.- Specific Developments in Sentinel Node Labeling Using 99mTc-Colloids.- Experience with and Suggestions for Cancer of Different Types and in Different Sites.- General Techniques in Surgical Investigations.- Radiation-Detecting Systems.- Quality Criteria of Gamma Probes: Requirements and Future Developments.- Statistical Evaluation in Detection of the SLN(s).- Are the Technical Conditions for SLN Detection Satisfactory?.- Breast Cancer Diagnosis Based on Histopathology and/or Cytopathology Before Sentinel Lymph Node Labeling.- Success of Stereotactic Fine-Needle Aspiration Cytology Depending on Quality of Sampling.- Use of a Newly Developed Ultrarapid Immunohistochemical Method to Improve Security in Sentinel Node Investigation and Timing in Interdisciplinary Cooperation.- "Micrometastasis" Versus "Microinvolvement".- Preoperative Axillary Lymph Node Diagnosis Using Ultrasmall Particles of Iron Oxide Combined with MRT.- New Strategies and Devices for Combined Radiological and Histological Cancer Diagnosis - Exclusion or Confirmation.- Special Part The Sentinel Node Concept Related to Main Tumor Types and Subtypes: Applicability in Daily Routine Work.- Breast Cancer.- Thyroid Cancer.- Cancers of the Face, Nose, Pharynx, and Oral Cavity.- Lung Cancer.- Malignant Melanoma.- Esophageal andGastrointestinal Cancer.- SLN Staging in Carcinoids and Neuroendocrine Tumors.- The Sentinel Node Concept in Cancers of the Female Genitalia.- Cancers of the Male Genitalia.- Prostate Cancer: an Overview.- Cancers of the Urinary Tract.- Closing Remarks.- Therapy Regimens Used in Adjuvant and Neoadjuvant Treatment of the Discussed Tumor Types.